Elderly anemia

Neurological symptoms result from demyelination of the spinal cord and are potentially irreversible. The symptoms and signs characteristic of a vitamin B 2 deficiency include paresthesis of the hands and feet, decreased deep-tendon reflexes, unsteadiness, and potential psychiatric problems such as moodiness, hallucinations, delusions, and psychosis. Neuropsychiatric disorders sometimes develop independently of the anemia, particularly in elderly patients. Visual loss may develop as a result of optic atrophy. 

Studies have demonstrated that initiation of treatment for anemia before stage 5 CKD decreases mortality in patients with ESRD receiving dialysis, particularly in the elderly.33 The treatment of anemia can decrease morbidity, increase exercise capacity and tolerance, and slow the progression of CKD if target Hgb levels are achieved.34... 

CLL can have a variable clinical course, with survival ranging from months to decades. Low-risk disease is asymptomatic, and median survivals exceed 10 years intermediate risk is associated with lymphadenopathy and has median survivals of about 7 years and high-risk patients with anemia have median survivals of only 3 years.16,17 The typical low-risk patient is an elderly person without symptoms who is diagnosed on routine blood draw. The typical high-risk patient is middle-aged, and symptoms have brought the patient to his or her physician. 

Carbon monoxide (CO) is generated in incomplete combustion processes. In households the main sources are all kinds of fuel burners (fuel oil, wood, natural gas, coal etc.) and automotive exhaust gas. Carbon monoxide is an odorless and invisible gas, and, due to its affinity to hemoglobin, which is higher than that of oxygen, it reduces the blood s capacity to carry oxygen. Hence it is toxic, especially for unborn and small children as well as for the elderly or people with heart problems or anemia. Even small amounts of CO can be harmful. Tab. 5.6 gives an overview of the relation between CO concentration and the corresponding symptoms of intoxication. 

Age-related reductions in bone marrow reserve can render the elderly patient more susceptible to anemia that is caused by multiple minor and often unrecognized diseases (e.g., nutritional deficiencies) that negatively affect erythropoiesis. 

Anemia of chronic disease Anemia of the elderly Malignant bone marrow disorders Peripheral... 

Elderly patients with symptoms of anemia should undergo a complete blood cell count with peripheral smear and reticulocyte count, and other laboratory studies as needed to determine the etiology of anemia. 

Except during pregnancy and lactation, do not give folic acid in therapeutic doses greater than 0.4 mg/day until pernicious anemia has been ruled out. Do not include daily doses exceeding the Recommended Dietary Allowance in multivitamin preparations if therapeutic amounts are necessary, give folic acid separately. Elderly It may be prudent to consider the status of folate in people older than 65 years of age. 

Capsules/Oral solution - In clinical trials, elderly subjects had a higher frequency of anemia than did younger patients (see Warnings). 

Antiadrenergic] Uses HTN Action Centrally acting antihypCTtensive Dose Adults. 250-500 mg PO bid-tid (max 2-3 g/d) or 250 mg-1 g IV q6-8h Peds. 10 mg/kg/24 h PO in 2-3 doses (max 40 mg/kg/24 h q6-12h) or 5-10 mg/kg/dose IV q6-8h to total dose of 20 0 mg/kg/24 h X in renal insuff/elderly Caution [B (PO), C (IV), +] Contra Liver Dz MAOIs Disp Tabs, inj SE Discolors urine initial transient sedation/drowsiness frequent, edema, hemolytic anemia, hepatic disorders Interactions T Effects W/ anesthetics, diuretics, levodopa, Li, methotrimeprazine, thioxanthenes, vasodilators, verapamil T effects OF haloperidol, Li, tolbutamide effects W/amphetamines, Fe, phenothiazine, TCAs ... 

The answer is D. Several vitamin deficiencies can cause anemia due to reduced DNA synthesis in the erythropoietic cells of the bone marrow, especially folic acid and vitamin Bj2 (cobalamin), which are particularly prevalent among elderly patients due to poor diet and reduced absorption. In addition, deficiencies of either folic acid or vitamin Bj2 could produce the megaloblastic anemia seen in this patient. However, the absence of neurologic symptoms, a hallmark of vitamin Bj2 deficiency, makes that diagnosis less likely than folic acid deficiency. 

Male Insomnia, chills, decreased libido, hepatic dysfunction, nausea, diarrhea, prostatic hyperplasia (elderly), iron deficiency anemia, suppression of clotting factors... 

Hematologictoxicity (thrombocytopenia, neutropenia, leukopenia, megaloblastic anemia) is more likely to occur in elderly, debilitated, or alcoholic patients in patients with impaired renal function and in those receiving prolonged high dosage. 

Like folate and vitamin C, vitamin B6 (pyroxidine) is water soluble and like folate has several vitamers. Vitamin B6 may be involved in more bodily functions than any other nutrient (Tambasco-Studart et al., 2005), is a cofactor for many enzymes, especially those involved in protein metabolism, and is also a cofactor for folate metabolism. Vitamin B6 has anticancer activity (Theodoratou et al., 2008), is a strong antioxidant (Denslow et al., 2005), is involved in hemoglobin biosynthesis, lipid and glucose metabolism and immune and nervous system function. Possible consequences of deficiency include anemia, impaired immune function, depression, confusion, and dermatitis (Spinneker et al., 2007). Vitamin B6 deficiency is generally not a problem in the developed world, but there could be as yet poorly defined consequences of suboptimal intake particularly for the elderly. 

Considerable concern exists regarding the occurrence of idiosyncratic blood dyscrasias with carbamazepine, including fatal cases of aplastic anemia and agranulocytosis. Most of these have been in elderly patients with trigeminal neuralgia, and most have occurred within the first 4 months of treatment. The mild and persistent leukopenia seen in some patients is not necessarily an indication to stop treatment but requires careful monitoring. The most common idiosyncratic reaction is an erythematous skin rash other responses such as hepatic dysfunction are unusual. 

Navarro JF, Mora C. Androgen therapy for anemia in elderly uremic patients. Int Urol Nephrol. 2001 32 549-557. 

Most common adverse effects include nausea, vomiting, diarrhea, abdominal pain, bone marrow depression with agranulocytosis, thrombocytopenia, and aplastic anemia. Cumulative toxicity is possible in elderly patients, hence it should be used cautiously. Care also should be exercised in patients with cardiac, hepatic, and renal dysfunctions. Colchicine causes teratogenicity in animals, and there are evidences of the risk of fetal chromosomal damage in humans. Colchicine should not be administered by the parenteral route as it causes severe local irritation. 

In North America and the United Kingdom, there is growing concern that many elderly subjects with mild or no anemia and normal serum B12 concentrations are suffering from preventable and correctable vitamin B12 deficiency disease. Today, in economically advanced countries, as many as 75% of vitamin B12-deficient patients present with various neurological symptoms, including somatic and autonomic neuropathies, myelopathies, cortical atrophy, and dementia (Carranza, 2002). In addition, vitamin B12-depleted subjects may develop postoperative myeloneuropathy when exposed to anesthesia... 

Carmel R Prevalence of undiagnosed pernicious anemia in the elderly. Arch Int Med 156 1097-1100,1996. 

In anemia of critical illness, the mechanism for RBC replenishment and homeostasis is altered by, for example, blood loss or cytokines, which can blunt the erythropoietic response and inhibit RBC production. Age-related reductions in bone marrow reserve can render the elderly patient more snsceptible to anemia that is cansed by multiple minor and often nnrecognized diseases (e.g., nntritional deficiencies) that negatively affect erythropoiesis. 

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